20
⃣ C. Transposition of the great vessels
⃣ D. Pulmonary atresia
⃣ E. Ventricular septal defect
6 A 2-day-old newborn female is diagnosed with
pulmonary stenosis, overriding of the aorta, ventricular septal defect, and hypertrophy of the right ventricle.
Which of the following embryologic mechanisms is most likely responsible for the development of this cluster of anomalies?
⃣ A. Superior malalignment of the subpulmonary infundibulum
⃣ B. Defect in the aorticopulmonary septum
⃣ C. Endocardial cushion defect
⃣ D. Total anomalous pulmonary venous con nections
⃣ E. Atrioventricular canal malformation
7 A 5-year-old boy is admitted to the hospital with
severe dyspnea. During physical examination a loud systolic murmur and a wide, fi xed, split S 2 sound is noted. What is the most likely diagnosis?
⃣ A. Ventricular septal defect
⃣ B. Atrial septal defect
⃣ C. Tetralogy of Fallot
⃣ D. Transposition of the great arteries
⃣ E. Aortic stenosis
8 A 3-month-old infant is diagnosed with Down
syndrome. A routine cardiovascular examination re- veals that the infant suffers from arrhythmias. What other cardiac conditions are most likely to occur with Down syndrome?
⃣ A. Tetralogy of Fallot
⃣ B. Transposition of the great arteries
⃣ C. Atrial septal and ventricular septal defects
⃣ D. Truncus arteriosus
⃣ E. Coarctation of the aorta
9 A 3-month-old infant is diagnosed with a deletion
at the 22q11 chromosome. A routine cardiovascular examination reveals severe congenital cardiac malfor- mation. Which of the following malformations will most likely be associated with 22q11 syndrome?
⃣ A. Tetralogy of Fallot and truncus arteriosus
⃣ B. Transposition of the great arteries
⃣ C. Atrial septal and ventricular septal defects
⃣ D. Coarctation of the aorta
⃣ E. Aortic atresia
10 A 28-year-old woman in her third trimester of
pregnancy with a complaint of dizziness for several days is admitted to the hospital. Physical examination reveals that she has diabetes mellitus. Which of the following cardiac malformations is most likely to affect the fetus when the mother has this disease?
⃣ A. Tetralogy of Fallot
⃣ B. Transposition of the great arteries
⃣ C. Atrial septal and ventricular septal defects
⃣ D. Truncus arteriosus
⃣ E. Coarctation of the aorta
11 During cardiac catheterization of a 6-year-old
child, the radiologist notes that the contrast medium released into the arch of the aorta is visible immedi- ately in the left pulmonary artery. What is the most likely explanation for this fi nding?
⃣ A. Atrial septal defect
⃣ B. Mitral stenosis
⃣ C. Patent ductus arteriosus
⃣ D. Patent ductus venosus
⃣ E. Ventricular septal defect
12 A 3-year-old male patient presents with a clini-
cally signifi cant atrial septal defect (ASD). The ASD usually results from incomplete closure of which of the following structures?
⃣ A. Foramen ovale
⃣ B. Ligamentum arteriosum
⃣ C. Ductus arteriosus
⃣ D. Sinus venarum
⃣ E. Coronary sinus
13 A premature infant has progressive diffi culty in
breathing and is diagnosed with respiratory distress syndrome. Which cells are defi cient in synthesizing surfactant in this syndrome?
⃣ A. Alveolar capillary endothelial
⃣ B. Bronchial mucous
⃣ C. Bronchial respiratory epithelium
⃣ D. Type I alveolar
⃣ E. Type II alveolar
14 A newborn baby was diagnosed with eventration
of the diaphragm. In this condition, half of the dia- phragm ascends into the thorax during inspiration, while the other half contracts normally. What is the cause of this condition?
⃣ A. Absence of a pleuropericardial fold
⃣ B. Absence of musculature in one half of the diaphragm
21
⃣ C. Failure of migration of diaphragm
⃣ D. Failure of the septum transversum to develop
⃣ E. Absence of a pleuroperitoneal fold
15 A 35-year-old male is admitted to the emergency
department because of a severe nosebleed and a head- ache that had become worse during the weekend. On physical examination his upper body appears much better developed than his lower body, a loud midsys- tolic murmur is present on his anterior chest wall and back, his lower extremities are cold, and femoral pulses are absent. Which of the following embryologic structure(s) has been most likely affected to produce such symptoms?
⃣ A. Bulbus cordis
⃣ B. Ductus arteriosus
⃣ C. Third, fourth, and sixth pharyngeal arches
⃣ D. Right and left horns of sinus venosus
⃣ E. Right cardinal vein
16 After a 2-day-old newborn male swallows milk he
becomes cyanotic. After 3 days he develops pneumo- nia. A tracheoesophageal fi stula is suspected. Failure of development has occurred most specifi cally in which of the following structures?
⃣ A. Esophagus
⃣ B. Trachea
⃣ C. Tongue
⃣ D. Tracheoesophageal septum
⃣ E. Pharynx
17 After a 2-day-old newborn male swallows milk he
becomes cyanotic. After 3 days he develops pneumo- nia. A tracheoesophageal fi stula is suspected. Which of the following conditions is most likely to be associated with a tracheoesophageal fi stula?
⃣ A. Oligohydramnios
⃣ B. Rubella
⃣ C. Polyhydramnios
⃣ D. Thalidomide
⃣ E. Toxoplasmosis
18 A 2-day-old newborn male develops mild cyano-
sis. An ultrasound examination reveals a patent ductus arteriosus. Which of the following infections will most likely lead to this congenital anomaly?
⃣ A. Toxoplasmosis
⃣ B. Rubella
⃣ C. Cytomegalovirus
⃣ D. Varicella virus
⃣ E. Treponema pallidum
19 A 5-year-old boy has frequent episodes of fatigabil-
ity and dyspnea. An ultrasound examination reveals an atrial septal defect, located at the opening of the superior vena cava. Which of the following types of atrial septal defects are characteristic for this description?
⃣ A. Ostium secundum
⃣ B. Ostium primum
⃣ C. Atrioventricular (AV) canal
⃣ D. Common atrium
⃣ E. Sinus venosus
20 A 3-day-old newborn was born with ectopia cor-
dis. Despite the efforts of doctors at the pediatric inten- sive care unit the infant died from cardiac failure and hypoxemia. Which of the following embryologic events is most likely responsible for the development of such conditions?
⃣ A. Faulty development of the sternum and peri- cardium, secondary to incomplete fusion of the lateral folds
⃣ B. Interruption of third pharyngeal arch development
⃣ C. Interruption of fourth pharyngeal arch development
⃣ D. Interruption of fi fth pharyngeal arch development
⃣ E. Faulty development of sinus venosus
21 A 2-day-old newborn male is admitted to the pe-
diatric intensive care unit with cyanosis and tachypnea.
Cardiac ultrasound and MRI examinations reveal to- tally anomalous pulmonary connections. Which of the following embryologic events is responsible for this malformation?
⃣ A. Abnormal septation of the sinus venosus
⃣ B. Abnormal development of the septum secundum
⃣ C. Abnormal development of the left sinus horn
⃣ D. Abnormal development of the coronary sinus
⃣ E. Abnormal development of common cardinal vein
22 A 3-day-old newborn has diffi culties breathing. A
CT scan of his chest and abdomen reveals the absence of the central tendon of the diaphragm. Which of the following structures failed to develop normally?
⃣ A. Pleuroperitoneal folds
⃣ B. Pleuropericardial folds
22
⃣ C. Septum transversum
⃣ D. Cervical myotomes
⃣ E. Dorsal mesentery of the esophagus
23 A 30-year-old man is diagnosed with a blockage
of arterial fl ow in the proximal part of the thoracic aorta. Brachial arterial pressure is markedly increased, femoral pressure is decreased, and the femoral pulses are delayed. The patient shows no external signs of infl ammation. Which of the following structures failed to develop normally?
⃣ A. Second aortic arch
⃣ B. Third aortic arch
⃣ C. Fourth aortic arch
⃣ D. Fifth aortic arch
⃣ E. Ductus venosus
24 A 1-year-old child was admitted to the pediatric
clinic due to severe dyspnea. ECG reveals cardiac ar- rhythmia and right ventricular hypertrophy. An angio- gram reveals a patent ductus arteriosus (PDA). From which of the following embryologic arterial structures does the PDA take origin?
⃣ A. Left sixth arch
⃣ B. Right sixth arch
⃣ C. Left fi fth arch
⃣ D. Right sixth arch
⃣ E. Left fourth arch
25 A 4-year-old girl is admitted to the hospital with
high fever. Staphylococcus aureus is isolated from her blood cultures and antibiotic therapy is initiated. A loud, harsh murmur is heard on auscultation. A chest radiograph shows prominent pulmonary arteries. Echo- cardiography shows all the valves to be normal. Which congenital heart disease most likely explains these fi ndings?
⃣ A. Atrial septal defect
⃣ B. Tetralogy of Fallot
⃣ C. Coarctation of the aorta
⃣ D. Patent ductus arteriosus
⃣ E. Aortic atresia
26 A 3-day-old infant is admitted to the cardiology
unit with severe cyanosis. During echocardiographic examination a right-to-left shunt is identifi ed. Which of the following conditions will most likely produce this type of shunt?
⃣ A. Interatrial septal defect
⃣ B. Interventricular septal defect
⃣ C. Patent ductus arteriosus
⃣ D. Corrected transposition of the great arteries
⃣ E. Common truncus arteriosus
27 A 4-day-old infant was admitted to the pulmonary
unit suffering from dyspnea and cyanosis. Radiographic examination revealed a left hypoplastic lung and her- niation of abdominal intestines into the left thoracic cavity. Which of the following embryologic structures most likely failed to develop properly?
⃣ A. Septum transversum
⃣ B. Pleuroperitoneal membrane
⃣ C. Tracheoesophageal septum
⃣ D. Laryngotracheal groove
⃣ E. Foregut
28 A 3-month-old infant is diagnosed with a ven-
tricular septal defect (VSD) at the area of the subpul- monary infundibulum. Which of the following struc- tures must be avoided carefully by the surgeon when the sutures are placed at the site of the defect?
⃣ A. Right bundle branch
⃣ B. Right coronary artery
⃣ C. Tricuspid valve
⃣ D. Left anterior descending coronary artery
⃣ E. Aortic valve
29 A 2-day-old infant is diagnosed with incomplete
division of the foregut into respiratory and digestive portions. Which is the most common congenital condi- tion characteristic of this description?
⃣ A. Esophageal atresia
⃣ B. Esophageal achalasia
⃣ C. Tracheoesophageal fi stula
⃣ D. Congenital diaphragmatic hernia
⃣ E. Esophageal fi stula
30 An unconscious 2-month-old infant is admitted to
the emergency department after an automobile colli- sion. An emergency tracheostomy is performed. Which of the following structures is most commonly at high risk of injury during this procedure?
⃣ A. Left brachiocephalic vein
⃣ B. Left common carotid artery
⃣ C. Vagus nerve
⃣ D. Phrenic nerve
⃣ E. Thoracic duct
31 A 45-year-old female is admitted to the hospital
with diffi culty breathing. Radiographic examination re-
23 veals a tumor invading the lung surface anterior to the
hilum. Which nerve is most likely compressed by the tumor to result in dyspnea?
⃣ A. Phrenic
⃣ B. Vagus
⃣ C. Intercostal
⃣ D. Recurrent laryngeal
⃣ E. Cardiopulmonary
32 A 62-year-old male patient expresses concern that
his voice has changed over the preceding months. Im- aging reveals a growth located within the aortic arch, adjacent to the left pulmonary artery. Which neural structure is most likely being compressed to cause the changes in the patient’s voice?
⃣ A. Left phrenic nerve
⃣ B. Esophageal plexus
⃣ C. Left recurrent laryngeal nerve
⃣ D. Left vagus nerve
⃣ E. Left sympathetic trunk
33 A 39-year-old woman visits the outpatient clinic
and complains of inability to reach a pantry shelf just above her head. History reveals that 2 months ago she underwent a mastectomy procedure and she did not have this complaint prior to the surgery. Which nerve was most likely damaged during surgery to result in the patient’s complaint?
⃣ A. Axillary
⃣ B. Spinal accessory
⃣ C. Long thoracic
⃣ D. Radial
⃣ E. Thoracodorsal
34 A 41-year-old female is admitted to the emer-
gency department with a complaint of severe, sharp, but poorly localized pain on the chest wall. Radio- graphic examination gives evidence of pleural effusion.
What is the location of the neuronal cell bodies respon- sible for the nerve fi bers that carry this pain to the central nervous system (CNS)?
⃣ A. Dorsal root ganglia
⃣ B. Sympathetic chain ganglia
⃣ C. Dorsal horn of the spinal cord
⃣ D. Lateral horn of the spinal cord
⃣ E. Ventral horn of the spinal cord
35 A 23-year-old man is admitted to the emergency
department after an automobile collision. Physical ex- amination reveals tachycardia. What is the location of
the preganglionic neural cell bodies involved in in- creasing the heart rate?
⃣ A. Deep cardiac plexus
⃣ B. Dorsal motor nucleus of vagus
⃣ C. Lateral horn T5 to T9
⃣ D. Lateral horn T1 to T4
⃣ E. Superior, middle, and inferior cervical ganglia
36 A 55-year-old male is admitted to the emergency
department with a diagnosis of possible myocardial infarction. Which nerves carry pain fi bers from the heart to the CNS?
⃣ A. Vagus
⃣ B. Greater thoracic splanchnic
⃣ C. Least thoracic splanchnic
⃣ D. Cardiopulmonary (thoracic visceral)
⃣ E. T5 to T9 ventral rami
37 A 17-year-old girl is admitted to the hospital with
severe dyspnea. Physical examination reveals that the patient is suffering from an asthma attack, with associ- ated bronchospasm. Which of the following nerves is responsible for the innervation of the bronchial smooth muscle cells?
⃣ A. Greater thoracic splanchnic
⃣ B. Phrenic
⃣ C. Vagus
⃣ D. Intercostal
⃣ E. Lesser thoracic splanchnic
38 A 42-year-old woman is admitted to the hospital
with an inability to speak. The patient’s personal his- tory reveals that she has experienced hoarseness for the past month. A chest radiograph reveals a mass at the aortopulmonary window. Which of the following nerves is most likely compressed?
⃣ A. Vagus
⃣ B. Phrenic
⃣ C. Left recurrent laryngeal
⃣ D. Right recurrent laryngeal
⃣ E. Greater thoracic splanchnic
39 Following the diagnosis of breast cancer, a 42-
year-old woman underwent a total mastectomy, includ- ing excision of the axillary tail (of Spence). Postopera- tively, the patient complains of dysesthesia in the inner aspect of the arm and axilla. Which of the following nerves was most likely injured during the procedure?
⃣ A. Ulnar
⃣ B. Long thoracic
24
⃣ C. Intercostobrachial
⃣ D. Lateral cutaneous nerve of T4
⃣ E. Axillary nerve
40 A 39-year-old male is admitted to the hospital
with a complaint of severe retrosternal pain that radi- ates to the left shoulder. The pain is relieved by lean- ing forward. Auscultation reveals a pericardial fric- tion rub, leading to a diagnosis of pericarditis. Which of the following nerves is responsible for the radiat- ing pain?
⃣ A. Intercostobrachial
⃣ B. Phrenic
⃣ C. Long thoracic
⃣ D. Greater thoracic splanchnic
⃣ E. Cardiopulmonary
41 A 72-year-old male is admitted to the hospital
with complaints of severe chest pain radiating to his left arm. ECG examination provides evidence of signifi - cant myocardial infarction of the posterior wall of the left ventricle. Which of the following nerves is respon- sible for the radiation of pain to the arm during myo- cardial infarction?
⃣ A. Phrenic
⃣ B. Vagus
⃣ C. Intercostobrachial
⃣ D. Greater splanchnic
⃣ E. Suprascapular
42 A 43-year-old male hunter is admitted to the
emergency department after falling over a barbed wire fence, as a result of which he suffered several deep lacerations along the left midaxillary line. When the patient is examined in the outpatient clinic sev- eral days later, numbness and anhydrosis are ob- served anterior to the area of the cuts. Which struc- tures were most likely damaged to result in these signs?
⃣ A. Dorsal roots
⃣ B. Ventral roots
⃣ C. Cutaneous branches of dorsal rami
⃣ D. Cutaneous branches of ventral rami
⃣ E. Rami communicans
43 A 62-year-old patient is admitted to the hospital
with a complaint of suddenly occurring, tearing pain radiating to his back. A CT examination reveals that the patient has an aortic aneurysm. An urgent placement of an endovascular stent-graft is ordered. Which of the
following nerves are most likely responsible for the tearing sensation radiating to his back?
⃣ A. Somatic afferent
⃣ B. Thoracic visceral afferent
⃣ C. Sympathetic postganglionics
⃣ D. Sympathetic preganglionics
⃣ E. Parasympathetic afferent
44 A 22-year-old woman had undergone elective
breast enhancement, with the insertion of 250-ml sa- line bags bilaterally. This resulted, unfortunately, in loss of sensation bilaterally in the nipples and areolae and some reduction of sensation of the skin from the areolae laterally to the midaxillary lines. Which of the following nerves were most likely subject to iatrogenic injury?
⃣ A. Anterior cutaneous branches of second and third intercostal nerves
⃣ B. Anterior and lateral cutaneous branches of the fourth intercostal nerves
⃣ C. Lateral pectoral nerves
⃣ D. Cutaneous branches of the second thoracic spinal nerves (intercostobrachial nerves)
⃣ E. Lateral cutaneous branches of the second and third intercostal nerves
45 A 32-year-old female is admitted to the emer-
gency department with dyspnea, dysphagia, hoarse- ness, and severe anxiety. Her medical history reveals that she has lived on a liquid diet for some months and has lost more than 30 lb. Over the past several weeks, she has had bloody sputum during attacks of coughing.
Fluoroscopy and a barium swallow reveal a 4-cm mass associated with a bronchus and associated compres- sion of the esophagus. Which of the following nerves is most likely to be affected?
⃣ A. Right recurrent laryngeal nerve
⃣ B. Left vagus nerve, posterior to the hilum of the lung
⃣ C. Left recurrent laryngeal nerve
⃣ D. Greater thoracic splanchnic nerve
⃣ E. Phrenic nerve
46 A 35-year-old man is admitted to the hospital
with pain on swallowing. Imaging reveals a dilated left atrium. Which structure is most likely being com- pressed by the expansion of the left atrium to result in the patient’s symptoms?
⃣ A. Esophagus
⃣ B. Root of the lung
⃣ C. Trachea
25
⃣ D. Superior vena cava
⃣ E. Inferior vena cava
47 A 32-year-old female is admitted to the hospital in
a comatose state. Physical examination reveals that the patient suffers from anorexia nervosa. A nasogastric tube is ordered to be inserted. What is the last site at which resistance would be expected as the tube passes from the nose to the stomach?
⃣ A. Pharyngoesophageal junction
⃣ B. Level of the superior thoracic aperture
⃣ C. Posterior to the aortic arch
⃣ D. Posterior to the left main bronchus
⃣ E. Esophageal hiatus of the diaphragm
48 A 59-year-old man is admitted to the hospital with
severe chest pain. During examination a slight rhythmic pulsation on the chest wall at the left fi fth intercostal space is noted in the midclavicular line. What part of the heart is responsible for this pulsation?
⃣ A. Right atrium
⃣ B. Left atrium
⃣ C. Aortic arch
⃣ D. Apex of the heart
⃣ E. Mitral valve
49 A 42-year-old male was admitted to the hospital
after a head-on vehicular collision in which he received severe blunt trauma to his sternum from the steering wheel. What part of the heart would be most likely to be injured by the impact?
⃣ A. Right ventricle
⃣ B. Apex of left ventricle
⃣ C. Left ventricle
⃣ D. Right atrium
⃣ E. Anterior margin of the left atrium
50 A 54-year-old male is admitted to the hospital
with dyspnea. Imaging and physical examination and echocardiographic studies reveal severe mitral valve prolapse. Auscultation of this valve is best performed at which location?
⃣ A. Left fi fth intercostal space, just below the nipple
⃣ B. Right lower part of the body of the sternum
⃣ C. Right second intercostal space near the lateral border of the sternum
⃣ D. Directly over the middle of the manubrium
⃣ E. Left second intercostal space near the lateral border of the sternum
51 A 48-year-old male patient is admitted with
chronic angina. Coronary angiography reveals nearly total blockage of the circumfl ex artery near its origin from the left coronary artery. When this artery is ex- posed to perform a bypass procedure, what accompa- nying vein must be protected from injury?
⃣ A. Middle cardiac
⃣ B. Great cardiac
⃣ C. Small cardiac
⃣ D. Anterior cardiac
⃣ E. Posterior cardiac
52 A 55-year-old patient is to undergo a coronary
bypass operation. The artery of primary concern is the vessel that supplies much of the left ventricle and the right and left bundle branches of the cardiac conduc- tion system. Which artery is the surgeon most con- cerned with?
⃣ A. Right marginal
⃣ B. Anterior interventricular
⃣ C. Circumfl ex
⃣ D. Artery to the sinoatrial (SA) node
⃣ E. Posterior interventricular
53 A 58-year-old patient presents himself to the
emergency department with severe angina. Upon car- diac catheterization, it is found that he has a signifi cant occlusion in his right coronary artery, just distal to the right sinus of the aortic valve. His collateral cardiac circulation is minimal. Assuming the patient is right coronary dominant, which of the following arteries would be most likely to still have normal blood fl ow?
⃣ A. Right (acute) marginal artery
⃣ B. Atrioventricular nodal artery
⃣ C. Posterior interventricular artery
⃣ D. Sinoatrial nodal artery
⃣ E. Anterior interventricular artery
54 A 55-year-old male is admitted to the emergency
department with severe chest pain. Coronary angiogra- phy reveals that the patient’s right coronary artery is free of pathology. The left coronary artery is found to be 70% to 80% occluded at three points proximal to its bifurcation into the circumfl ex and left anterior de- scending arteries. Having a left dominant coronary circulation, and without surgery, what is the most likely explanation for a poor prognosis for recovery of this patient to a normally active life?
⃣ A. All the branches of the coronary artery are end arteries, precluding the chance that anas- tomotic connections will occur.